Viagra, the "blue diamond" pill, has revolutionized the treatment of sexual dysfunction. Now get ready for a wave a new Viagra-like drugs. There are no fewer than five competitors being developed right now, as health reporter Paul Moniz found.
Viagra takes at least 45 minutes to produce an erection, so researchers are looking at everything from a quick-acting cream to two versions of a nasal spray. "When using a nasal spray delivery system," says Dr. Robert Salant, a urologist at the New York University Medical Center, "that time could decrease to approximately 10 minutes."
There's even a supercharged pill, Cialis, being researched by ICOS/Eli Lilly, whose effects reportedly last 48 hours.
"What we're seeing now is not just about living longer--it's about living longer and living better," says Dr. Evan Goldfischer of the Hudson Valley Urology Center in Poughkeepsie, New York. He was involved in the testing of Androgel, a testosterone gel that was recently approved.
Why so many new products? For one, it's a huge market. Thirty million US men suffer from erectile dysfunction, or E.D., and doctors say millions more experience gradual sexual decline as they age. According to a recent study from the University of Chicago, nearly half of all women and one-third of men have experienced sexual dysfunction in the past year.
And, despite its success, only about 13% of men with E.D. actually take Viagra. It costs $10 a pill and there are side effects like headaches, vision changes, and cardiac complications. Viagra has been implicated in some deaths, mostly heart patients. And many men are embarrassed to request Viagra by name. "It takes a lot of energy to go to a doctor and say, 'I can't make it in bed, doc,'" explains Dr. Alan Melman, chairman of urology at Montefiore Medical Center. But he adds that, as more drugs go to market, the lingering stigma of E.D. will continue to erode and the drugs will become faster acting with fewer side effects.
For example the cream Alprox-TD, being developed by a company called NexMed, promises an erection in 15 minutes. The manufacturer says it can be used by heart patients. "There's no interaction with nitrate medication, like Viagra," says James Yaeger, vice president of research and development. It has already been approved in China and could be available in the United States in 18 months.
Female sexual dysfunction has been more difficult to define and measure, though there are products in development for women, too, and for good reason. Sexual dysfunction affects four in ten women and Viagra doesn't seem to be nearly as effective in women as in men.
One device offering hope is an FDA-approved clitoral stimulation device called EROS-CTD, which is designed to help women achieve orgasm. It costs $350 and is manufactured by UroMetrics of St. Paul, Minnesota.
There is also a female version of the topical male cream--to be called Feprox--and a testosterone patch for women. The patch, to be marketed by Proctor and Gamble Pharmaceuticals, is small and discreet and worn on the lower abdomen. In a study, it increased sex drive and sexual pleasure in women.
Many of these products are expected to be on pharmacy shelves by the end of next year. Says urologist Evan Goldfischer, people "don't have to live with the problem anymore. There are excellent therapies out there."
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